Provider Demographics
NPI:1255474870
Name:GHAEMMAGHAMI, ARASH MOHRDAR (DC)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:MOHRDAR
Last Name:GHAEMMAGHAMI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3528
Mailing Address - Country:US
Mailing Address - Phone:951-781-4529
Mailing Address - Fax:951-781-8198
Practice Address - Street 1:3816 12TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3528
Practice Address - Country:US
Practice Address - Phone:951-781-4529
Practice Address - Fax:951-781-8198
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21062111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21062Medicare UPIN